Staff Survey Research Articles

Policy and Practice Changes Associated with a Tobacco-Free Initiative in Residential Substance Use Disorder Treatment

ABSTRACT A California-sponsored, 18-month, tobacco-free intervention in residential substance use disorder (SUD) programs was associated with increases in tobacco-free grounds and tobacco-related client services. The current study examined whether positive results would be replicated in 11 programs participating subsequently. Program directors (N = 11) completed surveys of tobacco-related policies pre- and post-intervention. Pre- (n = 163) and post-intervention (n = 128) cross-sectional staff surveys examined tobacco-related training, beliefs, practices, smoking policy, and smoking status. Directors reported increases in tobacco-free grounds (from 3 to 8 programs), tobacco-related staff training (1 to 10 programs), tobacco cessation staff services (1 to 9 programs) and nicotine replacement therapy (NRT) provision (6 to 10 programs). At post-intervention, staff were more likely to report smoke-free workplaces (p = 0.008), positive beliefs about treating tobacco use (p = 0.017) and less likely to report current smoking (p = 0.003). Clinical staff were more likely to report tobacco-related training receipt (p = 0.001), program-level NRT provision (p = 0.009) and conducting tobacco-related client services (p < 0.0001) post-intervention. Findings of increases in tobacco-free grounds and tobacco cessation client services corroborated prior results. These and the additional finding of decreases in staff smoking strengthen evidence that initiatives supporting tobacco-free policies can be successfully implemented in SUD treatment.

«KiKli Fit» – The effects of a specifically designed physical activity program on cognitive and motor performance in children with cancer: A multicenter crossover trial

Introduction Children with cancer are at an increased risk for various physical and cognitive challenges due to their illness and its treatment. A concerning observation is that young cancer patients often lead sedentary or even lying lifestyles, clearly failing to meet the WHO’s recommendation of 60 minutes of moderate-to-vigorous physical activity (PA) daily. This is alarming considering that PA is essential for physical and mental health, e.g., for the development of motor skills and cognitive functions (Bull et al., 2020). However, PA promotion in acute care in Swiss pediatric oncology units is hardly existent. Therefore, the aim of this project is to develop and conduct a physical activity program in a pediatric oncology unit and investigate its effects on cognitive and motor performance. Methods Part A of this project involved a qualitative study conducted at the Inselspital Bern’s pediatric oncology unit, aiming to design a tailored PA therapy program. This part included patient interviews and staff surveys. Part B, which is ongoing, focuses on a forthcoming two-arm multicenter crossover-controlled trial. This trial will compare the exercise therapy and PA counseling (intervention group in Bern, n = 40) with standard treatment (control group in Basel, n = 40). Participants will be aged 6-18 years, newly diagnosed with cancer and undergoing cytotoxictreatment for at least six weeks. The 12-week program will consist of thrice-weekly, 45-minute sessions of individualized exercise, aligned with the SK2-guidelines, NAOK, and international Pediatric Oncology Exercise Guidelines (Götte et al., 2022; Wurz et al., 2021). The sessions will focus on motor skills and cognitively challenging PA. In addition, children will receive 4 exercise counseling sessions. To evaluate the study, there will be three measurement points (once at admission, after twelve weeks of intervention and one follow-up after six months). The outcome measures include motor and cognitive performance, physiological and psychosocial functioning. Results Initial findings from the qualitative study indicate a strong patient and staff interest in exercise therapy. The study also provided valuable insights for developing and implementing the intervention. Discussion/conclusion The results will reveal important insights relevant to research and practice. Adopting a research perspective, the results will shed light on the effects of PA on cognitive performance in acute cancer care. Adopting a more applied perspective, PA has been neglected in Swiss pediatric oncology units so far. Therefore, this study may contribute to proof the effectiveness of PA for childhood cancer patients and thus help implementing it in standard care in the long term.

How well are US communities planning for resilience, climate adaptation, and sustainability—and what’s missing? Results of a national survey of local staff and officials

Community resilience, climate adaptation, and sustainability planning are increasingly used by communities in the United States to prepare for the effects of natural hazards and climate change. Existing studies have examined the theoretical intersections of these planning initiatives, but knowledge remains limited about practitioner perceptions and needs. We surveyed local community staff conducting resilience, climate adaptation, and sustainability planning to understand their experiences and views about prioritization and effectiveness, barriers to success, and external information and support for these approaches. Respondents generally reported success in their planning efforts across all three areas, and with respect to navigating the growing array of available information and support options. The latter suggests that technical limitations are no longer a serious impediment. However, securing funding and implementing plans remain important barriers to effective resilience, adaptation, and sustainability planning. Yet, observed conceptual and practical overlaps between these related concepts may signal a way forward.

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol

IntroductionEarly sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood...

Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme.

Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist. To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey. Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

Deimplementation of Gastric Residual Volume Monitoring to Enhance Patient Nutrition.

Routine gastric residual volume monitoring remains common in nursing practice. However, current evidence supports using a focused nursing assessment to identify signs and symptoms of enteral feeding intolerance such as abdominal pain, abdominal distension, and vomiting. At the author's institution, nurses and other clinicians began reporting inconsistencies in gastric residual volume monitoring along with frequent interruptions in the delivery of enteral nutrition. The quality improvement project included patients in the medical intensive care unit receiving enteral nutrition. Gastric residual volume monitoring was eliminated. Instead, enteral nutrition was suspended on the basis of signs and symptoms of enteral feeding intolerance. Multimodal education was provided to nurses, nurse practitioners, and physicians caring for these patients. Formative evaluation occurred via staff rounds, summative evaluation occurred through a staff survey, and nutritional adequacy was evaluated by tracking patient weight. The 6-week project included 37 patients on the medical intensive care unit service. Of these patients, 28 gained weight; the mean change in weight was +6.2%. The practice change was well perceived by staff and is now an established part of care for any patient receiving enteral feedings at the study hospital. The deimplementation of routine gastric residual volume monitoring is supported by evidence. Use of a focused gastrointestinal nursing assessment to identify enteral feeding intolerance is safe, feasible, and effective and improves nutrition delivery and nurses' workflow.

Quality Improvement Report: Improving Retrieval Time for CT Supplies by Using 5S.

The CT supply room is a critical resource in the imaging workflow. However, the supply room for the two CT scanners at our cancer center, one of which is used for our busy interventional service, was disorganized, and the time spent searching for the appropriate equipment could potentially lead to delays in service and contribute to patient safety risks. The purpose of this project was to reduce the time to find supplies and to increase the satisfaction of CT technologists and medical providers by reorganizing and clearly labeling supplies using "lean" principles. A multidisciplinary team was assembled to reorganize the CT storage using lean 5S methodology (sort, set in order, shine, standardize, and sustain). Baseline and postintervention analysis of the impact of supply reorganization and labeling was performed using three methods: (a) the time recorded for a supply retrieval scavenger hunt, (b) a spaghetti diagram of participant movement during the scavenger hunt, and (c) satisfaction surveys of radiologists and staff. Seven radiology residents participated in the timed supply retrieval scavenger hunt before and after the intervention. Spaghetti diagrams demonstrated a reduction in redundant foot traffic for supply retrieval after the intervention. There was a 61.7% decrease in the average time to retrieve the 10 items in the scavenger hunt (P < .01). Satisfaction surveys after the intervention had statistically significant positive responses compared with those before the intervention. ©RSNA, 2024.

Tularemia From Veterinary Occupational Exposure.

Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia.

2035 The Feasibility to Staff of Patient Specific Music Choice on Elderly Care Wards - A Post Intervention Survey

Abstract Introduction Receptive music listening has been shown to reduce depression, anxiety, and agitation in older adults. However, unfiltered and disruptive noise can increase confusion and agitation. Yet, during hospitalization older patients often have little control over when and for how long they are exposed to music, the genre which is heard, or they may have no access to music. Furthermore, older persons have reduced ability to use modern technology to counter this and their sensory and functional impairments may further isolate them. This study aimed to assess the feasibility of offering two one-hour daily sessions of patient specific music (PSM) choices on an elderly-care ward. Methods On a district general hospital elderly-care ward a 5-day trial of offering two one-hour daily sessions of PSM, using enhanced wireless speakers optimally positioned with daily amended music playlists based on specific patient choice. Ambient noise was minimised with regular decibel monitoring. A post-intervention staff survey was completed to assess the feasibility of continuing, the perceived impact on staff and patients and potential barriers to continuation. Thematic analyses were completed on the survey. Results In the post-intervention feasibility survey (n=14) the majority of staff (86%) agreed that it was possible, implementable and the procedure easy to use. In the impact assessment (n=19) 80% of staff stated it had a positive effect on patients and 89% stated it had a positive effect on staff. Thematic analyses on impact identified benefits to: work, engagement, enjoyment, physical activity and well-being. Barriers that were identified included patient choice, repetition of music, patients unable to engage with the process and staff availability for consistent delivery. Conclusion Playing patient specific music choice was feasible and acceptable to staff with a perceived positive influence on both staff and patients. Further studies are now required to assess the impact on patient outcomes.

1987 Capillary blood glucose testing on older inpatients at the Norfolk and Norwich University Hospital (NNUH)

Abstract Rationale Inpatient glycaemic management is a challenge in older people. Clinicians at the Norfolk and Norwich University Hospital noticed substantial numbers of finger-prick capillary blood glucose (CBG) tests being documented. This quality improvement project explored the frequency of CBG testing on older people’s medicine wards, to determine if improvements in service provision and patient safety could be made. Methods Setting: Electronic records of inpatients on geriatric medicine wards at NNUH (May-July 2023) Patient selection: Older people with recorded CBG testing Measures: Type of diabetes, medication regime and frequency of CBG testing. Staff survey of CBG monitoring knowledge. Analysis: Compliance with the Joint British Diabetes Societies for Inpatient Care guidelines for frail older adults with diabetes (February 2023). Staff knowledge. Results 240 inpatients included - 23% had type 2 diabetes. 32% had regular CBG monitoring (once daily or more). Of these patients, 70% had tests that were not compliant with guidance. In a single day, we calculated 120 CBG tests that were not clinically indicated. 43% of patients were on single-therapy treatment (not including sulphonylureas) or diet-controlled type 2 diabetes, all of whom underwent excessive testing during their inpatient stay. A staff survey of 15 ward sisters, nurses and healthcare assistants revealed no consensus on who determines frequency of CBG testing and target CBG ranges for frail, older inpatients. Conclusions Ad hoc CBG testing has resulted in potential harm to our inpatients and overuse of staff time and resources. Future work is underway to ‘Think Glucose’ and implement protocols for appropriate CBG monitoring frequencies and target CBG ranges for our inpatients.

Trends in emotional wellbeing during COVID-19 by ethnicity, age and gender: evidence from a higher education staff survey

This paper provides evidence of the trends in the emotional wellbeing of university staff during the COVID-19 pandemic, with a focus on differences according to age, gender and ethnicity. From June 2020 to July 2021 a survey was circulated to University College London staff, capturing information on self-described demographic indicators (age, gender, and ethnicity), satisfaction with academic life, and mental and emotional wellbeing. Results show a moderate level of emotional wellbeing overall, with scores increasing after lockdowns were lifted. Some significant heterogeneity within the demographic variables demonstrates the need for disaggregating the categories within Black and Minority Ethnic individuals. Black Caribbean and Black African staff reported higher levels of emotional wellbeing (respectively, 0.60 and 0.81 higher wellbeing scores, on average) while staff who identified as Arab or “other” reported lower levels (on average −1.0 and −0.65) than staff who identified as White. There was a sharp increase in emotional wellbeing for Arab staff and a slight increase in Asian and “other” ethnic staff. Findings from this research provide evidence into the trends in emotional wellbeing of faculty and staff in a United Kingdom university context, contributing to the literature focusing on higher education during the pandemic period. We also flag the importance of disaggregating Black and Minority Ethnic categorization to describe and better understand the diverse impact on emotional wellbeing within different ethnic groups, which has rarely been explored in the literature assessing university staff wellbeing.

Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK.

Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.

Inadvertent perioperative hypothermia prevention strategies for urology surgical patients who received a blood transfusion: A retrospective analysis.

This study aimed to establish whether hypothermia was present in patients who required a blood transfusion and underwent a urology procedure, as well as identify staff knowledge and understanding. A staff survey was conducted with respondents from a range of clinical settings, with some staff working across more than one area. A retrospective review of 46 medical records was conducted between January 2021 and July 2022. All data were exported into an Excel spreadsheet and analysed. Staff (70%) were unaware of guidelines informing thermoregulation practices; however, 90% understood the importance of normothermia in the perioperative environment. Medical record review demonstrated temperature monitoring and intervention implementation varied across the perioperative journey, with 20% of patients hypothermic on admission and 89% of the cohort having two or more risk factors. There is no formal process for the management of inadvertent perioperative hypothermia throughout the patient journey at the hospital. A variety of intrinsic factors (age, patient comorbidities, American Society of Anaesthesiologists score) and external factors (patient waiting times, anaesthetic modality, type of procedure, environmental influences), impact each patient's risk of inadvertent perioperative hypothermia.

A Tubular-Mounted Digital Camera Versus Optical Surgical Microscope for Minimally Invasive Lumbar Decompression Surgery: The Impact on Operative Times, Ergonomics, and Workflow

ObjectivesUnderstanding the ergonomic impact is foundational to critically evaluate the value and safety of enabling technologies in spinal Minimally Invasive Spine Surgeries (MISS). This study assessed the impact of tube-mounted digital camera (TMDC) vs. optical surgical microscope (OSM) in single-level MISS on operative times, durotomy rate, surgeon ergonomics, safety, and operating room workflow. MethodsIn a retrospective study, we compared consecutive single-level MIS lumbar decompression surgeries with TMDC (Sep 2021-Jun 2022) to a historical OSM cohort (Jan 2020-Jul 2021). Data included patient demographics, operative times, durotomy incidence, surgeon ergonomics (REBA scores), and equipment impact via staff surveys. T-tests assessed operative times, while Pearson chi-squared tests compared sex. Age, BMI, and CCI comparisons used Wilcoxon rank-sum tests, and survey results were analyzed with Wilcoxon signed-rank tests. ResultsIn total, 74 and 82 patients were included in the TMDC and OSM groups, respectively. Age, sex, and CCI did not significantly differ between both groups. The TMDC group had a higher BMI (29. 6 ± 5.1) versus the OSM group (29.0 ± 7.5) (p=0.04). The TMDC group (n=74) had significantly shorter operative times (57.3±16.6 minutes) compared to the OSM group (n=82) (66.7±22.5 minutes) (p=0.004), with no difference in durotomy rates (p=0.42). TMDC use yielded lower REBA scores (3) vs. OSM (4.1±0.77) (p<0.001). Surveys indicated improved safety, setup time, and workflow with TMDC (p<0.001). ConclusionsTMDC in single-level MIS lumbar decompression surgery improved surgeon ergonomics, reduced operative times, and maintained durotomy rates, enhancing operative room efficiency. Evaluating technology's ergonomic impact is vital for safety and value assessment.

Survey of staff experiences of potential stigma during the COVID19 pandemic.

The impact of COVID-19 on everyone's lives has been significant. However, there is also another factor related to the well-being of healthcare workers (HCWs) and that is how they are perceived by the general public. The aim of this study is to provide insight into the scope of this potential problem and describe how HCWs perceive community views and if this influences provision of patient care. A paper-based survey was conducted within mental health wards and community services as well as medical and surgical wards of a large metropolitan hospital in Queensland. Exploratory Factor Analysis was used to explore the dimensionality of the HCW stigma scale from the staff survey. Confirmatory Factor Analysis was used to assess validity and reliability. A total of 545 staff (67.9% nursing, 6.6% medical, 14.7% Allied Health and 10.8% Administrative) completed the survey between June and July 2020. Exploratory Factor Analysis showed that five factors explained 55% of the variance and represent factors of (i) Alienation, (ii) Social isolation, (iii) Perceived workplace harmony, (iv) Perceived job demands, (v) Clinical self-efficacy. The survey displayed high internal reliability and discriminant validity was observed for all subscales. Australian HCW's reported feeling well supported at work and appreciated by society in general during the pandemic, possibly because Australian healthcare services were better prepared than those countries that first experienced COVID-19.

Engaging healthcare professionals and patient representatives in the development of a quality model for hospitals: a mixed-method study.

Top-down and externally imposed quality requirements can lead to improvement but do not seem as sustainable as intended. There is a need for a quality model that intrinsically motivates healthcare professionals to contribute to quality and safe care in hospitals. This study shows how a quality model that matches the identity and the quality vision of the organization was developed. A multimethod design with three phases was used in the development of the model at a large teaching hospital in Belgium. In the first phase, 14 focus groups and 19 interviews with staff members were conducted to obtain an overview of the quality and safety challenges, complemented by a plenary discussion with the members of the patient advisory council. In the second phase, the challenges that had been captured were further assessed using a hospital-wide survey for all hospital staff. Finally, a newly established quality review board (with internal and external stakeholders) critically evaluated the input of Phases 1 and 2 and defined the basic quality standards to be implemented in the hospital. A first evaluation 2 years after the implementation was conducted based on (i) patients' perceptions of quality of care and patient safety by publicly available indicators collected in 2016, 2019, and 2022 and (ii) staff experiences and perceptions regarding the acceptability of the new model gathered through (grouped) interviews and an open questionnaire. The quality model consists of eight broad themes, including norms for the hospital staff (n = 27), sustained with quality systems (n = 8), and organizational support (n = 6), with aid from adequate management and leadership (n = 6). The themes were converted into 46 standards. These should be supported within a safe, efficient, and caring work environment. The new model was launched in the hospital in June 2021. The evaluation shows a significant difference in quality and safety on different dimensions as perceived by hospitalized patients. The perceived added value of the participatory model is a better fit with the needs of employees and the fact that the model can be adjusted to the specific context of the different hospital departments. The lack of hard indicators is seen as a challenge in monitoring quality and safety. The participation of various stakeholders inside and outside the organization in defining the quality challenges resulted in the creation of a participatory quality model for the hospital, which leads towards a better-supported quality policy in the hospital.

Privacy and confidentiality in Massachusetts' post-overdose outreach programs: Mixed methods analysis of outreach staff surveys and interviews

BackgroundPublic health-public safety partnerships for post-overdose outreach have emerged in many communities to prevent future overdose events. These efforts often identify overdose survivors through emergency call data and seek to link them with relevant services. The aim of this study was to describe how post-overdose outreach programs in Massachusetts manage the confidentiality of identifiable information and privacy of survivors. MethodsIn 2019, 138 Massachusetts programs completed surveys eliciting responses to questions about program operations. Descriptive statistics were calculated from the closed-ended survey responses. Thirty-eight interviews were conducted among outreach staff members during 2019–2020. Interview transcripts and open-ended survey responses were thematically analyzed using deductive and inductive approaches. ResultsOf programs that completed the survey, 90 % (n = 124/138) reported acting to protect the privacy of survivors following overdose events, and 84 % (n = 114/135) reported implementing a protocol to maintain the confidentiality of personal information. Interviews with outreach team members indicated substantial variation in practice. Outreach programs regularly employed discretion in determining actions in the field, sometimes undermining survivor privacy and confidentiality (e.g., by disclosing the overdose event to family members). Programs aiming to prioritize privacy and confidentiality attempted to make initial contact with survivors by phone, limited or concealed materials left behind when no one was home, and/or limited the number of contact attempts. ConclusionsDespite the establishment of privacy and confidentiality protocols within most post-overdose outreach programs, application of these procedures was varied, discretionary, and at times viewed by staff as competing with engagement efforts. Individual outreach overdose teams should prioritize privacy and confidentiality during outreach to protect overdose survivors from undesired exposure. In addition to individual program changes, access to overdose survivor information could be changed across all programs to bolster privacy and confidentiality protocols. For example, transitioning the management of overdose-related information to non-law enforcement agencies would limit officers’ ability to disseminate such information at their discretion.

Intent to stay, moral distress, and nurse practice environment among long-term care nurses: A cross-sectional questionnaire survey study.

Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment. The purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress. This study was a descriptive, cross-sectional survey using targeted sampling. A total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting. This study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses. The mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001). Since the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession. Our study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Waste or resource? Investigating the interplay of structural d waste managers' household food waste interventions.

Globally, food waste is a significant environmental, economic and social issue. Food waste in landfill creates the potent greenhouse gas, methane, contributing to climate change, with its management predominantly falling to local governments. Despite efforts by many countries, and extensive infrastructure and market development funding, food waste continues to be landfilled, with apparently similar councils taking diverse approaches. Using a mixed methods study design, data was firstly collected from a National online survey of Australian council-based waste management staff (n = 183), with descriptive and factor analysis of the survey data revealing a strong sense of structural empowerment (PCA.75 to.90) and a preference for sourcing information from networks (48%). These results informed a series of semi-structured interviews (n = 43) which, after thematic analysis, provided rich insights into the attitudinal and situational interpretations council-based waste managers bring to decisions around household food waste management. Framed by four pillars of Structural Empowerment, the findings suggest that waste manager's attitude is equally as important as support, resources, and knowledge and that, despite mandates and targets, individual motivational factors and organisational paradigms determined decision-making. Identified barriers included perceived capacity constraints, inadequate focus on actionable interventions, and fragmented, uninspiring, planning. This article provides important insights around 1) leveraging networks for knowledge dissemination, 2) fostering capacity-building initiatives, and 3) advocating for sustained engagement with food waste diversion within councils. This underscores the need for additional research into evolving council typologies and effectively engaging key stakeholders to achieve food waste diversion targets and address climate change impacts.

Identifying and prioritising barriers to injury care in Northern Malawi, results of a multifacility multidisciplinary health facility staff survey.

The burden of injuries globally and in Malawi is substantial. Optimising both access to, and quality of, care in health systems requires attention. We aimed to establish how health facility staff in Karonga, Malawi, perceive barriers to seeking (delay 1), reaching (delay 2) and receiving (delay 3) injury care. We conducted a cross-sectional survey of health facility staff who treat patients with injuries in all health facilities serving the Karonga Demographic Surveillance Site population. The primary outcome was participant perceptions of the importance of delays 1 to 3 following injury. Secondary outcomes were the barriers within each of these delays considered most important and which were considered the most important across all delays stages. 228 staff completed the survey: 36.8% (84/228) were female and 61.4% (140/228) reported being involved in caring for an injured person at least weekly. Delay 3 was most frequently considered the most important delay 35.1% (80/228), with 19.3% (44/228) and 16.6% (38/228) reporting delays 1 and 2 as the most important respectively; 28.9% (66/228) of respondents either did not know or answer. For delay 1 the barrier, "the perceived financial costs associated with seeking care are too great", was considered most important. For delay 2, the barrier "lack of timely affordable emergency transport (formal or informal)" was considered most important. For delay 3, the barrier, "lack of reliably available necessary physical resources (infrastructure, equipment and consumable material)" was considered most important. When considering the most important overall barrier across all delays, the delay 3 barrier, "lack of reliably available necessary physical resources" received the most nominations (41.7% [95/228]). Given the awareness of health facility staff of the issues facing their patients, these findings should assist in informing health system planning.